BESST + Standard Care for Suicide Prevention

Overseen By Korie Rice, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: White River Junction Veterans Affairs Medical Center

Disqualifiers: Prisoners, Institutionalized, Involuntarily committed, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a suicide prevention program called BESST (Building VA Engagement, Self-efficacy, and Social Support To Prevent Suicide) to determine its effectiveness for rural Veterans who have recently left mental health treatment. The study compares two groups: one receiving usual care and another receiving usual care plus BESST, which includes an educational session and follow-ups. The researchers aim to find out if adding BESST can improve outcomes related to suicide risk. Veterans discharged from a VA mental health setting and connected to specific VA Medical Centers might be suitable for this trial. As an unphased trial, this study offers Veterans a unique opportunity to contribute to innovative research that could enhance mental health support systems.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems likely that you can continue them, but you should confirm with the study team.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the study team or your healthcare provider.

What prior data suggests that the BESST program is safe for suicide prevention in rural Veterans?

Research has shown that the BESST program aims to prevent suicide by teaching suicide prevention, building confidence, fostering social connections, and encouraging mental health treatment. Similar programs in past studies have improved mental health by reducing suicidal thoughts and feelings of being a burden.

Although detailed safety information for BESST is not available, the program includes educational sessions and follow-up check-ins, which are generally safe and non-invasive. This suggests that participants typically tolerate the program well.

Overall, based on the nature of the BESST program and findings from similar programs, it appears safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the BESST intervention for suicide prevention because it combines innovative techniques with standard mental health care to enhance outcomes. Unlike traditional treatments that primarily focus on medication and therapy alone, BESST integrates comprehensive strategies that might include digital tools, personalized support, or novel therapeutic approaches. This combination aims to address underlying factors that contribute to suicidal thoughts more effectively, potentially offering faster, more personalized care for individuals at risk.

What evidence suggests that the BESST intervention could be effective for suicide prevention in rural Veterans?

Research has shown that the BESST program, which includes suicide prevention education, confidence building, and social support, may improve outcomes related to suicide. In this trial, participants in the BESST intervention arm will receive the BESST program alongside standard mental health care. Studies have found that similar programs can reduce suicidal thoughts and actions in individuals with mental health issues. Early results suggest these programs enhance feelings of connection and involvement in mental health care, leading to better outcomes. While specific data on BESST is still being gathered, its methods resemble those that have successfully reduced suicide risk in other research. ^{1 2 3 6 7}

Who Is on the Research Team?

Natalie Riblet, MD MPH

Principal Investigator

White River Junction VA Medical Center

Are You a Good Fit for This Trial?

This trial is for Veterans over 18, recently discharged from VA community mental health care, at risk of self-harm, and connected to specific VAMCs. They must speak English and be able to consent. Those not clinically appropriate or in vulnerable groups won't be included.

Inclusion Criteria

Be a Veteran

Be a patient connected to the White River Junction VAMC, the Togus VAMC, or the Manchester VAMC

The patient was recently discharged from a VA community care mental health treatment setting

Exclusion Criteria

I am unable to understand and give consent for treatment.

We do not plan to enroll any potentially vulnerable populations including prisoners, institutionalized patients, or involuntarily committed patients

Study physician deems the patient not clinically appropriate

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the BESST intervention combined with standard care or standard care alone

12 weeks

1 one-hour educational session, 7 follow-up check-ins (~30 minutes each)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• BESST

Trial Overview The study tests the BESST suicide prevention program alongside standard care against standard care alone for rural Veterans post-discharge. It involves an educational session, follow-up check-ins, and assessments over three months to see if BESST improves outcomes.

How Is the Trial Designed?

Group I: Control Experimental Treatment 1 Intervention

Patients randomized to the control arm will receive standard mental health care alone.

Group II: BESST Experimental Treatment 2 Interventions

Patients randomized to the BESST intervention arm will receive the BESST intervention combined with standard mental health care.

Who Is Running the Clinical Trial?

White River Junction Veterans Affairs Medical Center

Lead Sponsor

Trials

32

Recruited

17,900+

VHA Office of Rural Health

Collaborator

Trials

1

Recruited

30+

Published Research Related to This Trial

A brief behavioral intervention for suicidal veterans was designed and implemented in VA emergency departments, highlighting the importance of these settings in identifying and treating at-risk individuals.

Initial evaluations indicate that the intervention is feasible and acceptable, suggesting it could be effectively adapted for use in various healthcare environments, including community emergency departments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An emergency department-based brief intervention for veterans at risk for suicide (SAFE VET). Knox, KL., Stanley, B., Currier, GW., et al.[2022]

The U.S. Department of Veterans Affairs Home-Based Primary Care (HBPC) program has developed an online suicide prevention toolkit specifically for mental health providers and their teams, addressing the unique needs of Veterans with multiple health conditions.

A needs assessment involving focus groups and surveys of 109 HBPC program directors and mental health providers revealed a demand for targeted training and additional resources for managing mental health issues, highlighting the importance of integrated care teams in suicide prevention efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of a Suicide Prevention Toolkit for VA Home-Based Primary Care Teams. Mlinac, ME., Smith, RW., Siffert, KJ., et al.[2023]

The SAFE VET protocol aims to test a brief intervention that combines Safety Planning Intervention with structured follow-up to effectively reduce suicide risk among Veterans in emergency departments.

This study addresses a significant gap in evidence-based interventions for Veterans at risk of suicide, focusing on enhancing their engagement in outpatient behavioral health treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rationale and study protocol for a two-part intervention: Safety planning and structured follow-up among veterans at risk for suicide and discharged from the emergency department. Currier, GW., Brown, GK., Brenner, LA., et al.[2022]

The study will evaluate 'Project Life Force' (PLF), a novel intervention combining skills training and social support with safety planning, to see if it reduces suicidal behavior in high-risk Veterans compared to standard treatment, involving 265 participants in a randomized clinical trial.

The primary focus is on measuring the incidence of suicidal behavior during follow-up, with secondary outcomes assessing factors like depression and coping strategies, highlighting the comprehensive approach to understanding and addressing suicide risk in Veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group ("Project Life Force") versus individual suicide safety planning: A randomized clinical trial. Goodman, M., Brown, GK., Galfalvy, HC., et al.[2020]

A study involving 39 hospice staff members showed that training in suicide prevention significantly increased their awareness of risk factors, with nearly 80% reporting improved understanding.

Participants' self-efficacy scores also significantly improved after training, indicating that such programs can effectively enhance the skills and confidence of hospice staff in addressing suicidal thoughts among patients and caregivers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suicide prevention training program for gatekeepers working in community hospice settings. Matthieu, MM., Swensen, AB.[2022]

Suicide prevention has been recognized as a critical public health priority in the U.S., with a national strategy updated in 2012 and a recent Call to Action in 2021 emphasizing the need for a comprehensive approach to address various factors contributing to suicide.

Despite a slight overall reduction in suicide rates recently, significant increases were noted from 1999 to 2018, particularly affecting specific groups like adolescents, veterans, and American Indians/Alaskan Natives, highlighting the need for targeted outreach and innovative prevention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing the national suicide prevention strategy: Time for action to flatten the curve. Iskander, JK., Crosby, AE.[2022]

A survey of 1002 U.S. veterans revealed that while many are aware of suicide prevention programs like the Veterans Crisis Line (65% awareness), participation in community events related to these programs is very low (only 5%).

Younger veterans and those with more medical conditions are more likely to be aware of the VA's suicide prevention resources, indicating a need for targeted outreach to ensure that at-risk veterans, especially those without a history of suicidality, are informed about available support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Awareness of Suicide Prevention Programs Among U.S. Military Veterans. Tsai, J., Snitkin, M., Trevisan, L., et al.[2022]

A study involving 31 participants showed that a multidisciplinary, assertive outreach model of post-suicidal care significantly reduced suicidal ideation and distress while improving resilience and well-being at least 6 months after discharge.

Qualitative feedback highlighted the importance of staff support in recovery, suggesting that effective post-suicidal care can enhance protective psychological factors and sustain improvements in mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Provision of a Multidisciplinary Post-Suicidal, Community-Based Aftercare Program: A Longitudinal Study. Kehoe, M., Wright, AM., Lee, SJ., et al.[2023]

Veterans have a significantly higher suicide rate than the general US population, with nearly 14% of adult suicides involving veterans, highlighting a critical public health issue.

Only 47% of veterans are enrolled in the VA Healthcare System, indicating a need for improved access to care and a proactive approach from all healthcare providers to recognize and mitigate suicide risk factors among veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Practical Review of Suicide Among Veterans: Preventive and Proactive Measures for Health Care Institutions and Providers. Ruiz, F., Burgo-Black, L., Hunt, SC., et al.[2023]

A brief intervention and contact (BIC) program significantly reduced completed suicides among 680 suicide attempters, with an odds ratio of 35.4, indicating a strong protective effect.

The BIC program also lowered the rate of subsequent suicide attempts, with an odds ratio of 17.3, suggesting that this low-cost intervention could be an effective suicide prevention strategy in healthcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intervention for suicide attempters: A randomized controlled study. Vijayakumar, L., Umamaheswari, C., Shujaath Ali, ZS., et al.[2021]

The SAFER intervention was implemented successfully at 18 community events, reaching 1175 participants, with 61% finding it highly valuable, indicating its acceptability among those at higher risk for suicide.

Following the SAFER intervention, there was a significant increase in safe firearm storage practices (from 51.2% to 66.0%) and safe medication storage (from 14.8% to 21.6%), along with improved awareness that most firearm fatalities are due to suicide (from 33.4% to 45.8%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SAFER brief community intervention: a primary suicide prevention strategy to improve firearm and medication storage behaviour. Stuber, JP., Massey, A., Meadows, M., et al.[2022]

In a randomized controlled trial with 148 U.S. Army Soldiers, the Collaborative Assessment and Management of Suicidality (CAMS) was found to significantly reduce suicidal ideation (SI) compared to enhanced care as usual (E-CAU) by 3 months, with a strong effect size (Cohen's d = 0.93).

Both CAMS and E-CAU led to improvements in various behavioral health outcomes, but CAMS showed a notable advantage in reducing suicidal thoughts, highlighting its potential as an effective intervention for Soldiers with significant suicidal ideation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality versus Enhanced Care as Usual With Suicidal Soldiers. Jobes, DA., Comtois, KA., Gutierrez, PM., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10562975/

Pilot Randomized Controlled Trial of a Brief Strategy to ... VA BIC aims to teach patients about suicide prevention, build self-efficacy, foster social connection, and encourage treatment engagement. VA ...

2. research.va.gov research.va.gov/topics/suicide.cfm

Suicide Prevention Psychosocial interventions are effective in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8955571/

A virtual, pilot randomized trial of a brief intervention to ... VA BIC aims to educate patients about suicide prevention, bolster self-efficacy, and treatment engagement. A primary focus of the intervention is to encourage ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2949875923002072

Pilot randomized controlled trial of a brief strategy to ... Pilot data suggest VA BIC may improve suicidal ideation & perceived burdensomeness. •. VA BIC may improve engagement in mental healthcare in first month post ...

5. hsrd.research.va.gov hsrd.research.va.gov/publications/esp/suicide-prevention-REPORT.pdf

Population and Community-based Interventions to Prevent ... Develop clinical policies informed by evidence;. • Implement effective services to improve patient outcomes and to support VA clinical practice.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10189833/

Effectiveness of Suicide Safety Planning Interventions Evidence across a range of studies indicates that SSP is effective for reducing suicide behavior (SB) and ideation (SI).

7. mentalhealth.va.gov mentalhealth.va.gov/docs/data-sheets/2023/2023-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf

2023 National Veteran Suicide Prevention Annual Report The report covers veteran suicide data from 2001-2021, including 2021, the first full year of COVID-19 data, and shows increases in 2021. Some age groups saw ...